HomeMy WebLinkAbout331 PARK ST - APPLICATIONS - 10/17/2011COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
Fort Collins
281 N. College Ave. • Fort Collins, CO 80522-0580 • Phone: 970-221-6760
www.fcgov.com/building
BUILDING PERMIT APPLICATION
APPLICATION NUMBER I I O V APPLICATION DATE ' ' ` ] ,
Job Site Address 137�5 / Pcr k st Unit #
PROPERTY OWNER INFO: (All owner information is required -it is not optional) Phone #
Last name ThlNNDccn -
Ki'Mnlel First Name tl14MY1 �x'�� MCti-e Middle
Street Address 33
far IL
City `� fi-" COIII AS
State G-U Zip OSZ
CONTRACTOR INFO: Company
Name S,JS'i•ctl`n.gble-
_54rycJitc Contractor Phone #
L176-21q-6b77
Lic Holder Name �Le Jt n
� uJbn
City of Fort Collins License #
Supervisor Cert #
Mailing Address 2 iT
Taf k, 5+rt.24—
City ':3r'{— 6011l'n,5 State
C0 Zip 9057Z
LEGAL INFO:
Subdivision/PUD
CONSTRUCTION INFO: Total Building Sq Ft (not including
Residential Sq Ft Comm'I Sq
1s' Floor Sq Ft
Finished Bsmt Sq Ft
2nd Floor Sq Ft
Filing # Lot # iJ Block # 31 Lot Sq Ft 616✓3-r
ement) Total Garage Sq Ft 3 ig
_ # of Stories Bldg Height # Dwelling Units
31d Floor Sq Ft
Unfiished Bsmt Sq Ft
# of Bedrooms # of Full Baths % Baths '/z Baths # of Fireplaces
Air Conditioning: Yes No Energy info: ( Circle appropriate choice ) 1. ComCheck 2. ResCheck w/Air Sealing
3. ResCheck w/Blower Door 4. Simulated Performance Alternative 5. Prescriptive w/Air Sealing 6. Prescriptive w/ Blower Door
City of Fort Collins Stock Plan #
UTILITIES INFO:
List appropriate option
Water Tap Size Sewer Tap Size Metered: Yes or No Temp. Pedestal Yes or No
Type of Heat: '[]Gas XIElectric Electric Main Breaker Size (Residential only) ❑ 150 Amp or Less ❑ 200 Amp ❑ Other
Value of Construction (including labor, material & profit) $ `) 0 ("-D
Description of Work: eAi'34C,' �6ra'je e'AA 111c;
Contact Name & Phone # of JOBSITE SUPERVISOR: Ke J;(\ UP_yAet\ ` 70 --? 1 "! -0677
Subcontractor Info:
Electrical %d 7 y g F1eC`t iG> Mechanical
Framer 5� 5+11Vc�vr-\- Roofing GofAo P,0d'AgConcrete
Solar
Other
Other
Plumbing 4le- Pjva, 6,
Fireplace
Other
Applicant: I hereby acknowledge that I have read this application and state that the above information is correct and agree to comply with all requirements
contained herein and City of F rt ollins nces and state laws regulating building construction. ��
Applicant Signature �� Print Name 14y,,rl De-wUm Phone g170-7/q-W7
Distribution: White - Office Yellow -Applicant Pink - WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE